Newswise — ST. LOUIS – As the number of older adults climbs at a faster pace in Missouri than nationally, Saint Louis University has started the first hospice and palliative medicine fellowship program in the state.
Palliative care physicians care for patients who need active treatment to manage a serious disease as well as those at the end of their lives. Many older adults receive palliative care, and Medicare recently announced plans to reimburse physicians for talking with their patients about end of life issues.
SLUCare Physician Group geriatrician Dulce Cruz Oliver, M.D., who is board-certified in hospice and palliative medicine and an assistant professor of internal medicine at SLU School of Medicine, directs of SLU’s new fellowship, which began in July.
“During the past five years that I have been an assistant professor of internal medicine at SLU, I’ve found that the more I worked with elders, the more passionate I have become about caring for those who are seriously ill, especially patients who are close to the end of their lives,” she said. “I love what we do and appreciate the opportunity to talk with our patients and really help them.”
The Hospice and Palliative Medicine Fellowship will train one physician this year in the subspecialty that cares for those who have chronic, life-changing illnesses like cancer, congestive heart failure or chronic obstructive pulmonary disease. Fourth year medical school students and residents also will receive training through a palliative care educational elective that is related to the program, Cruz added.
“Palliative care helps a patient adapt to all of the changes that come with a specific disease,” Cruz says. “This field creates an awareness of how important it is for doctors to treat the whole patient – not just his or her medical symptoms – to talk with and listen to patients.
“We need to hear from patients about their expectations and goals, and spend time with them to help them understand what is going on. For instance, we might explain to a patient how to complete an advanced directive or help a patient who has COPD deal with shortness of breath without taking a traditional medicine. We might help someone who is no longer able to work make that transition.”
In addition to the Hospice and Palliative Medicine Fellowship, Cruz has started the Supportive Care Clinic, a pilot program held twice a month for Saint Louis University Cancer Center patients who are referred by their physicians. “It’s not only a physician who provides the care, you need a team that might include a chaplain and social worker,” says Cruz, who is part of the treatment team.
Through specialized sessions, patients learn to experience their best possible quality of life as they deal with the emotional and psychological challenges presented by a cancer diagnosis. For example, they might explore ways to manage their pain that don’t involve taking drugs or strategies to cope with the anxiety that can accompany being diagnosed and treated for cancer. Cruz sees the service as an important addition to medical treatment, and is encouraged by how well the pilot program is being received.
Cruz’s interest in palliative care complements her medical specialty of geriatrics. As a little girl in Puerto Rico, Cruz saw her grandmother caring for members of their village who became ill, which inspired her to become a physician who takes the time to listen to the older adults she treats.
“My grandmother was a santigüera – a healer for her village in Lares, Puerto Rico. People would come to her with medical problems like joint pain or illnesses like shingles, and she prayed on them and gave them a natural remedy. I saw the impact of complementary medicine on our friends and family who looked to my grandmother for loving care.”
During her internal medicine residency, Cruz conducted research on palliative care, becoming intellectually drawn to the area of medicine. But after her medical training, her connection to the field became deeply personal as she watched a close friend battle ovarian cancer.
“The many difficulties and challenges she endured caused her and all of us around her to suffer. All of the things she went through would have been better if there had been a good palliative care program in place. I’m committed to training others to change the way palliative care is delivered in this city,” she said.
Cruz recently was selected as one of only 10 physicians or nurses in the nation into Cambia Health Foundation’s Sojourns Scholar Leadership Program, which cultivates the next generation of health care providers to advance the field of palliative care. The Sojourns Scholar program will support Cruz’s work at the Hospice and Palliative Medicine Fellowship and Supportive Care Center, in addition to funding professional development. Cruz will received mentoring in patient care from the Center to Advance Palliative Care, work on a research project at the National Institute of Aging and attend the Harvard Macy Institute to learn how to use new technologies to enhance the quality of her teaching.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: infectious disease, liver disease, cancer, heart/lung disease, and aging and brain disorders.
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